Search

We used the Bond Defense Style and Cloninger Tridimensional Personality questionnaires to assess defense styles and personality dimensions in subjects with anxiety and depressive disorders. When measured against a comparison group, maladaptive defense style scores were significantly higher in those with major depression, panic disorder, generalized anxiety disorder, and social phobia, and higher at a trend level in the subjects with obsessive-compulsive disorder and mixed anxiety and depression. However, there were no differences in adaptive defense style scores between the subjects and the comparison group. The harm avoidance personality dimension scores were significantly higher in subjects with both anxiety and depressive disorders than in the comparison group. The harm avoidance scores correlated positively with the maladaptive defense scores, but negatively with the adaptive defense scores. These findings are discussed in terms of severity of illness, level of functioning, and relationships between Axis I and II disorders.

The State-Trait Anxiety Inventory (STAI) is one of the most widely used scales for the evaluation of anxiety in medical and, to a lesser extent, psychiatric patients. Although there is a relatively large amount of STAI data about anxiety for individuals with a variety of psychiatric disorders, the results of many anxiety studies include only state or trait and many studies have been influenced by comorbidity and by variations in diagnostic criteria used. We studied state and trait anxiety and compared the revised form of the STAI (Form Y) with the original (Form X) to evaluate the anticipated improvement in the measure. In addition, we compared the STAI results with those of another self-report measure (the Symptom Checklist-90 anxiety and depression scales) and also with interviewer-rated measures of anxiety (Hamilton Rating Scale for Anxiety) and depression (Hamilton Rating Scale for Depression). Results indicate that the STAI does not clearly differentiate anxiety disorders from depressive disorders and support the use of multiple tests and of both self-report and interviewer ratings in the evaluation of anxiety and depression in psychiatric patients.

We studied the use of the Symptom Checklist-90 (SCL-90) to differentiate between specific anxiety and depressive disorders and/or their symptoms in 280 patients with 6 DSM-III-R diagnoses: major depression (MD), panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SP), obsessive-compulsive disorder (OCD), and mixed anxiety and depression (MAD). Using a comparison group, we found specific patterns for some of the diagnostic categories. Both the MD and MAD subjects had significantly high paranoid ideation, interpersonal sensitivity, hostility, and psychoticism, as well as high depression subscale scores; those with PD and GAD has the highest anxiety and somatization scores; and those with SP or OCD had a mixed pattern. When ranking the severity of psychopathology, the disorders ordered from most to least were MAD, MD, PD, GAD, SP, and OCD. Subsyndromal levels of symptoms frequently were associated with the various conditions. Use of the SCL-90 subscale helps to enlarge our understanding of the various anxiety and depressive disorders.

We studied Levenson's Internal (I), Powerful Others (P), and Chance (C) locus of control scales in 193 patients with six DSM-III-R diagnoses: Major Depression (MD), Panic Disorder (PD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Obsessive Compulsive Disorder (OCD), and Mixed Anxiety Depressive Disorder (MAD). Compared to the comparison groups (CG), we found specific patterns for some of the diagnostic categories. There were no significant differences between the I scale scores and of those in the different anxiety and depressive disorder groups and the CG. But, patients with MD, SP, or MAD had significantly higher P scale scores than the CG. Patients with MD, PD, SP, and MAD had higher C scale scores than the CG. The OCD patients had the lowest P and C scale scores of any of the groups and not significantly different than the CG. The findings have some research and clinical implications.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

The purpose of this study was to determine the utilization of medical specialists by anxiety disorder patients. The setting was a university's clinical outpatient drug trails for anxiety disorders. The participants were subjects identified by advertisement and diagnosed by psychiatric interviews and, in some instances, also by structured interviews. The main outcome measures were the subject responses on a questionnaire listing medical specialists. A total of 94 subjects were surveyed. Primary care physicians (family medicine and internal medicine) were seen more often by panic disorder (PD) subjects than by obsessive-compulsive disorder (OCD) or generalized anxiety disorder (GAD) subjects. Gastroenterologists were seen most frequently by the GAD subjects; dermatologists and cardiologists by the OCD subjects; and otolaryngologists, obstetricians-gynecologists, neurologists, and urologists by the PD subjects. The PD subjects saw more specialists than the subjects with the other disorders. Medical specialists need to increase identification of patients with various anxiety disorders to relieve suffering, improve health care practices, and obtain favorable cost:benefit ratios.

Even though anxiety in depression is a common clinical condition, there is controversy about its status. Can these patients be dichotomized as having either anxiety or depression, or are there three categories--certain anxiety states, anxiety in depression, and the specific depressive disorders? A review of the findings from four major lines of research on anxiety in depression reveals contradictory results. Anxious depression may be a distinctive entity. The guidelines for diagnosis presented here emphasize the necessity to identify anxious depressed patients and to differentiate them from those with distinctive anxiety states or depressive disorders. Tricyclic medications, such as doxepin, combined with supportive psychotherapy are the treatment of choice for patients with anxiety in depression.